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Cook County Health and Hospitals System Announces 1115 Medicaid Waiver

Cook County Board President Toni Preckwinkle and Health and Hospitals System (CCHHS) Chief Executive Officer Dr. Ram Raju today announced that pre-enrollment has started for Cook County residents who qualify for “CountyCare” a Medicaid benefits program for adults.

County Care is the new program approved under the federal government’s 1115 Medicaid Waiver which permits CCHHS to early enroll more than 115,000 individuals who will be eligible for Medicaid in 2014.

“This means we will have more resources to treat patients, provide more effective care and bolster the health system’s finances,” President Preckwinkle said. “These residents deserve to have access to basic health care services under Medicaid. That’s why I made approval of this waiver my top priority this year.”

Individuals will receive medical care from providers in the CCHHS system and select community providers. Covered services include primary and specialty physician care, inpatient and outpatient hospital care, mental health and substance abuse services, prescription drugs, labs and x-rays.

“This is by far the most important step that we can take to begin to transform the Cook County Health System to a patient-centric medical home,” Dr. Raju said. “Now that we have secured the waiver, we will begin enrolling patients, including many of the people we currently serve, into “CountyCare.” This health system is working to be the top medical home for Cook County residents to get the best medical care possible.”

With a focus on primary, preventive and chronic care, benefits include allowing patients to have access to and a connection with a primary care physician. This will ensure that care is being managed as patients move from primary to specialty to inpatient services.

To be eligible, an individual must live in Cook County, be 19-65 years of age, who have an income below 133% of federal poverty income are now eligible to enroll in and gain health care coverage within the Cook County Medicaid Network. For a two-person family, this means earning less than $20,123 per year. For a family of four, this means earning less than $30,657 per year; for a family of six the income threshold is $41,191.

The waiver is funded entirely by the federal government. The County and its taxpayers are currently assuming the costs for these uncompensated patients who, under the Waiver, will now be covered by Medicaid. The 1115 waiver will give the County’s Health System a head-start in getting ready for the future Medicaid managed care model, post 2014.

“This waiver gives Cook County a taste of what’s to come in 2014 when the full benefits of the Affordable Care Act will be realized and the federal government will pay 100 percent of the cost for all newly eligible Medicaid beneficiaries – which, in Illinois, will mean an additional 500,000 people will have access to health insurance at no cost to the state,” said U.S. Sen. Dick Durbin (D-IL).

“With this waiver, Cook County will expand Medicaid and provide health insurance to more than 100,000 county residents who have been living without the peace of mind that comes with being insured — and the federal government will pick up half of the tab,” Durbin said. “It is welcome news for the uninsured county residents who will, in short order, gain Medicaid coverage and for county taxpayers who have been footing the bill for the uncompensated care the County has long provided the uninsured. By providing waiver participants with a medical home where they will receive preventative care, early detection and coordinated care for the treatment of chronic diseases, we’ll be improving their quality of care and saving money in the long run as costly emergency room visits decrease.”

“I am thrilled that Cook County has received this Medicaid waiver thanks to the leadership of President Preckwinkle. It will allow us to lower costs by providing quality care and keeping people healthy, avoiding preventable problems. It provides both health security for over 100,000 currently-uninsured County residents and a great deal for Cook County taxpayers,” U.S. Rep Jan Schakowsky (D-IL).

The Medicaid waiver is expected to generate $99 million net revenue for the CCHHS budget.